A Dublin Student Doctor (43 page)

“Honestly? I didn’t think any medicine could do that.”

“This stuff called Red Prontosil just might. It’s a sulphonamide. Jesus, Bob, if it works for postpartum infections—remember Kevin Doherty?”

Bob nodded.

“We might finally have something to treat rheumatic fever with too, before
Streptococcus
damages the heart valves.” But too late for you, Kevin, he thought. Fingal gritted his teeth, finished tying on the mask, and said through the material, “Now, let’s go and see why we were summoned.”

Doctor Tweedy looked over his mask at the new arrivals. “Let me briefly recap for you two. Mrs. EL is a twenty-year-old primigravida.”

So it was her first pregnancy, Fingal thought, looking at a short, thin woman. She was pale, the bags under her eyes dark and deep. There was blood on her lower lip, probably because she had bitten it. Her gaze never left Doctor Tweedy’s face.

“Her estimated date of delivery was December twenty-eighth so today, January eighth, she is eleven days overdue. She went into labour at home some thirty-eight hours before she was admitted.”

Mrs. EL moaned and clutched her bulging belly.

Fingal marvelled at the endurance of women. Nearly two days in labour.

“The district midwife was summoned to the patient’s home on Railway Street early this morning, examined the patient, and concluded that the baby was lying longitudinally, vertex presentation, right occipito anterior.”

The child’s spine was aligned with its mother’s, it was coming headfirst, with the back of its head turned slightly to the right and facing the front of the mother’s abdomen. This was the normal lie and presentation.

“It was not engaged.”

So the widest part of its head hadn’t passed the pelvic brim.

“On rectal examination, the cervix was five shillings dilated and the vertex two knuckles.”

It was believed there was less risk of infection if the rectal route was used for examinations to assess the progress of labour. Using coin sizes to assess how far the cervix was dilated was routine, as was the use of “knuckles.” The midwife had described a cervix that had only completed half its necessary dilatation and the leading edge of the baby’s head was the distance between the second knuckle of her index finger from its tip and the tip from the pelvic floor. Both indicated poor progress.

“The midwife sensibly suggested the patient be brought here. Mrs. EL applied at the Porter’s Lodge for admission. The assistant master, Doctor Edmond Solomons, as is the custom, agreed. He put her under my care. It was determined that because of her social circumstances, the six-shillings-a-day hospital fee and my own would be waived.”

Fingal knew that all patients, except in these kinds of circumstances, were expected to contribute to the cost of their care. Rightly so, but money should not stand between a patient and proper help, and here, like in the twenty-five percent of beds set aside in Sir Patrick’s, it clearly wasn’t.

“It has taken us some time to assess her progress and have tests done. So altogether she has been in labour for forty-one hours. The adage is a true one, ‘Never, never let the sun set twice on the same labour.’ She has had a gruelling two days and has suffered many examinations,” said Doctor Tweedy, “so I will not invite any of you to repeat anything. Instead I will tell you, there has been no change in any of her physical findings. Labour has not progressed and her contractions are becoming less frequent and less powerful. She is clearly distressed. What does all that suggest?”

“Obstructed labour, sir,” Fitzpatrick called from where he stood at the front of the group, “due to a fault in one of the ‘Three
P
s.’”

“Which are?” Doctor Tweedy asked.

“The powers, the passenger, or the passages.”

“Very good. You,” Doctor Tweedy pointed at Charlie, “what could be wrong with the powers?”

“Either the uterine contractions simply aren’t strong enough, primary inertia, or more likely in this case, something else is delaying progress and the uterine muscles are exhausted trying to overcome it and are giving up. Secondary inertia.”

“Assuming there is a difficulty with Mister Fitzpatrick’s second
P,
the passenger, what might it be?”

Hilda Manwell said, “If the midwife is right, it is unlikely that a malpresentation could be responsible.”

“You, sir,” Doctor Tweedy nodded at Fingal. “Malpresentation?”

“When any part of the baby other than the head with the occiput anterior is trying to get into the pelvis. That would include—” Fingal had read up on the subject immediately after Professor Browne’s lecture. How much had he remembered? “Occipito-posterior, occipito-transverse, breech, face, brow, shoulder, and transverse lie.” Got ’em, he thought.

Doctor Tweedy smiled. “Been studying, I see.” He turned back to the other students. “Anything else that might be wrong with the passenger?”

“Yes, sir,” Fitzpatrick rushed in. “Abnormal size, malformations, double monsters—”

The patient screamed, high, piercingly, then yelled, “Jesus, Mary, and Joseph, my babby’s not a monster. It’s not.” She burst into tears.

You are an insensitive bastard, Fitzpatrick, thought Fingal. Could you not have said teratology for malformations, conjoined twins for double monsters? We’d have understood. She wouldn’t. Fingal now believed that keeping the patient in the dark often was a kindness, at least until the final diagnosis was in. That medical jargon wasn’t all hocus-pocus. Sometimes it was kindly meant.

Doctor Tweedy bent to her. “It’s all right, Mrs. Lannigan. I can promise you your baby’s absolutely normal and it’s going to be perfectly all right. I promise.” He took and held her hand. “Tactless, Mister Fitzpatrick,” he said levelly. “Very tactless.”

Fitzpatrick stepped back from his place in the front row. Fingal saw the submissive crouch the man often assumed when chastised. Would that eejit never learn?

“As you all can see, Mrs. Lannigan is upset, so I’ll come to the point. She has secondary uterine inertia, not because there is anything remotely wrong with the baby.” He patted her hand and was rewarded with a smile. “But because there is something in the passages holding things up. We have carried out some investigations and decided on a course of action before you all were summoned.” He turned to the resident houseman. “Doctor Milliken, please.”

The junior doctor, a sandy-haired, short man tending toward chubby, stepped forward and produced an X-ray. He held it up to the light.

Fingal craned forward. The baby’s skeleton was perfectly normal, as was its head.

“Please note,” said Doctor Tweedy, “the distortion of the pelvic brim into a figure-of-eight shape when it should be like a fat heart. The waist of the eight is too narrow.”

Fingal could see that clearly.

Doctor Tweedy bent to the patient. “It means that things are a bit tight and baby is having trouble getting through.”

She nodded, her little old woman’s eyes following his.

“So while I and the young doctors here have been discussing your case, the nurses have been getting things ready and we’re going to do a Caesarean section. Doctor Milliken and I will operate and the young doctors will observe. And you and your baby will be fine. I promise.”

So time hadn’t been wasted simply to teach, Fingal thought. Good. After six months of surgery, Fingal was not squeamish about the prospect of watching a Caesarean section.

He heard footsteps and the quiet rumbling of wheels. Two masked orderlies were bringing a trolley. “We’re going to take you to theatre now, Mrs. Lannigan.” Doctor Tweedy let go of her hand. “You’ll be fine.”

Fingal waited with the rest as she was moved to the trolley and trundled out of the ward.

“Now, before we go and get ready,” Doctor Tweedy said, “why do you think her pelvis is flat and contracted?”

“Rickets, sir,” Fingal said. “There’s never much sunlight in the tenement districts even on a good day. Pretty poor nutrition. Half the kiddies there have bow legs, twisted spines.”

“And deformed pelves,” the consultant said. “The tenements.” He pursed his lips. “Where grannys and handy women do half the deliveries.”

“Excuse me, sir,” Fingal asked, “handy women?”

“Lay women who help at confinements.”

Fingal frowned. “But, why wouldn’t a patient send for a midwife or use the dispensary doctor? It doesn’t cost anything if you don’t have a lot of money.”

Doctor Tweedy shook his head. “It’s not the money. Dublin women have a mortal fear of hospitals and so they hope if they don’t get professionals involved, things will work out all right at home. And often they do, but there can come a point when they have to come here or to one of the other hospitals and that often means the situation has become dire and, of course, if a death is involved—it’s not hard to understand why other pregnant women are terrified of institutions.”

“I don’t understand, sir,” the Scottish student said. “The patients come to us in Scotland. And Caesarean section’s pretty safe.”

“Until recently it wasn’t,” Doctor Tweedy said, “and the only safe option then for the mother was to crush the baby’s head so it could be delivered. You can see the instruments called cephalotribes and cranioclasts in the museum here.”

“Sounds pretty gruesome, sir,” Bob Beresford said.

Fingal saw Hilda shudder. And well she might. He’d already learned that petite women, even if they didn’t have rickets, were at much greater risk of obstructed labour because their pelves were small.

“And it was, if it was allowed to be done at all,” Doctor Tweedy said.

“Why wouldn’t it be?” Cromie asked.

“It is forbidden by the Catholic church. The mother would have been baptised and have a chance of Heaven. However, if the baby died before it could be baptised it would spend eternity in Limbo. The rule was simple. Make every effort to save the baby even if it cost the mother her life. I’m afraid I’ve had to do postmortem Caesarean sections just like the ancient Romans did.”

Barbaric superstitious nonsense, Fingal thought, but kept the thought to himself.

“Now, ladies and gentlemen, if you will please follow me to the theatre, I will take great pleasure in demonstrating the operation of Caesarean section.”

The procedure, Fingal thought, was said to have been performed on the mother of Robert the Bruce, King of Scotland, giving Shakespeare the model for Macduff, Macbeth’s nemesis.

The entourage headed off, Fingal at the rear. He’d been impressed with Doctor Tweedy. The man hadn’t hesitated to reassure a terrified woman, hold her hand, and yet it was obvious he was a master of the technicalities of his discipline. It strengthened Fingal O’Reilly’s resolve to be that kind of doctor—he chuckled at his own phrasing—when he grew up, in less than six months. He smiled and remembered Sister Daly using the exact words when she’d threatened to report him to Doctor Micks. “When you grow up.” He had matured since then. A lot.

42

Give Crowns and Pounds and Guineas, But Not Your Heart Away

“Good Lord, Fingal. Fingal O’Reilly? What on earth brings you here?” Virginia Treanor answered the front door of the converted three-storey house on Leeson Street. The petite blonde’s head usually only reached his shoulder, but from her vantage point up a short flight of sandstone steps she looked him in the eye.

“Mostly the tram,” he said, and managed a smile, “but I did walk a bit.”

“Oh, very good,” she said. “Incisive wit. Stunning repartée.” She rolled her eyes and shook her head, but said, “I know it is a fair stretch from Parnell Square to here. Cromie’s doing his midwifery there at the Rotunda so I know the other suspects including you are too.” She took a pace back and folded her arms across her chest. “I suppose you came to see Kitty?”

“Please.”

“I’m not sure I should let you. It’s been six months since you blew her out. You hurt her, Fingal. Would you not just leave her be?”

“I can’t.” He tried to ignore the pelting rain that shimmered as it flew past the streetlights and trickled under his raincoat collar.

Virginia sniffed. “Wait there. I’ll go and ask her.” She closed the door after her.

Fingal hunched his shoulders and stepped back a couple of paces on the narrow pavement. Would she see him? He’d not blame her if she wouldn’t, but he fervently hoped she’d not refuse. It might have been immediately after the foxhunt that he had decided he was going to ask her for another chance, but it had taken him until now, late January, to steel himself to do it.

Like the previous three times before Christmas when he’d headed here from Sir Patrick’s, he’d almost turned back tonight. He was unsure of whether he was scared of hurting her again or terrified of rejection. There was the other man.

A motorcar sped past, chucking up from the gutter a sheet of water as big as old
Tiger
’s bow wave. He turned and roared after the driver, “Slow down, you unmitigated bollix. You’re not Sir Malcolm Campbell.”

“Still the same O’Reilly,” he heard a familiar voice saying. “Come in, Fingal.”

Fingal spun and saw her in silhouette, the light coming from the hall behind her and making a halo of her hair. “Kitty,” he said. “I’m sorry.”

He started forward up the steps and she stepped aside to let him into the shared hall of the building, closed the door, and said, “You look in real rag order. You’re drenched. Give me your coat and cap.”

“Thank you.” Fingal snatched off his duncher, shrugged out of his coat, and handed them to her.

She hung them on one of a row of hooks to drip on the linoleum.

She’d changed her hairstyle. Before it had hung to her shoulders; now it was straight, parted to the left like a man’s. Three rolled waves stopped abruptly just below the tops of her ears. He didn’t like it and hoped it was a passing fad, not an outward sign that Kitty had decided to get rid of a lot of things from her past. “How have you been?” he asked, and shifted from one foot to the other, the question hanging in the air.

“I’ll be back in a couple of hours,” Virginia said as she left their shared flat and came into the hall. “
Top Hat
’s still showing. I love Fred Astaire and Ginger Rogers.” She grabbed her coat and left singing, “‘Isn’t it a lovely day, to be caught in the rain?’”